So, I'm a medical student. And lots of my friends are also medical students (hi guys)! Recently I've fielded a number of comments from that group of friends, along the lines of "So you're still breastfeeding, huh?"
My daughter is not yet 8 months old.
And then I realized...if I was just a medical student, and not also a new mom, I probably wouldn't know how long you're supposed to breastfeed, either!
God knows that that wasn't tested on Step 1 (the standardized test of medical knowledge taken after the first 2 years of medical school). And I don't know how much emphasis is given to breastfeeding during OB and pediatrics clinical rotations.
So, here's a little public service announcement for my medical student readers (and maybe some moms too):
The American Academy of Pediatrics recommends that "Breastfeeding should be continued for at least the first year of life, and beyond for as long as mutually desired by mother and child" [emphasis added; for full guidelines see here].
That's right, folks. At least a year. After the first teeth. After crawling. Possibly after walking and talking, depending on the baby. So, yeah, I'm still breastfeeding. We'll see how it goes once I'm back at school full-time (in a month--eek)! I'm expecting that I won't be able to pump quite as frequently as I currently nurse, and that my supply will gradually decline, but I hope to continue breastfeeding as much as possible until my daughter is a year old (and beyond, as the AAP says!).
If you're a medical student desirous of more information about the physiology and clinical management of lactation and breastfeeding, check out the AAP's online curriculum for residents in pediatrics.
Showing posts with label breastfeeding. Show all posts
Showing posts with label breastfeeding. Show all posts
Tuesday, March 1, 2011
Friday, February 4, 2011
Unbuttoned
Breastfeeding and pumping add a whole new danger to life for the absent-minded.
Just a few days ago, I had a 10-minute break between sessions of the medical school course I was helping to teach, so I zipped down the hall to the pumping room, pumped one bottle, and then ran back out to stash the bottle in a freezer before I went back to class.
I was halfway down the hallway before I realized that I had carefully buttoned the top button of my white collared shirt...while leaving the other buttons completely undone, the two sides of the shirt flapping open. !@%#$*! I ran back into the room, buttoned up, and then went back out again.
The fact is, when you breastfeed exclusively, you spend a LOT of time, um, hanging out. For me, the result is that I can now be completely uncovered, and not notice at all. I can't tell you how many times I've nearly walked into a meeting or class in an inappropriate state of undress.
If this sounds sexy, trust me, it's not. For one thing, nursing bras--at least the kind you can buy at Target--are not exactly titillating attire. For another, my breasts have become so functional, in my mind, that the idea that anyone would get turned-on by any amount of accidental exposure seems ridiculous. No, my episodes of near-flashing of strangers are about as sexy as a forgetful old man leaving his zipper undone.
A few times, I've gotten home and gone to the bathroom, only to discover that a button or two has been open for hours, or that the nursing flap on my bra is undone, leaving an unsightly fabric bulge under my shirt. And I think...if only someone had told me! Please. A discreet wave in the general area of your chest, with some raised eyebrows, will be plenty to clue me in. Gentlemen and gentle ladies, I thank you in advance!
Just a few days ago, I had a 10-minute break between sessions of the medical school course I was helping to teach, so I zipped down the hall to the pumping room, pumped one bottle, and then ran back out to stash the bottle in a freezer before I went back to class.
I was halfway down the hallway before I realized that I had carefully buttoned the top button of my white collared shirt...while leaving the other buttons completely undone, the two sides of the shirt flapping open. !@%#$*! I ran back into the room, buttoned up, and then went back out again.
The fact is, when you breastfeed exclusively, you spend a LOT of time, um, hanging out. For me, the result is that I can now be completely uncovered, and not notice at all. I can't tell you how many times I've nearly walked into a meeting or class in an inappropriate state of undress.
If this sounds sexy, trust me, it's not. For one thing, nursing bras--at least the kind you can buy at Target--are not exactly titillating attire. For another, my breasts have become so functional, in my mind, that the idea that anyone would get turned-on by any amount of accidental exposure seems ridiculous. No, my episodes of near-flashing of strangers are about as sexy as a forgetful old man leaving his zipper undone.
A few times, I've gotten home and gone to the bathroom, only to discover that a button or two has been open for hours, or that the nursing flap on my bra is undone, leaving an unsightly fabric bulge under my shirt. And I think...if only someone had told me! Please. A discreet wave in the general area of your chest, with some raised eyebrows, will be plenty to clue me in. Gentlemen and gentle ladies, I thank you in advance!
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| Hey mom, button your shirt! |
Monday, January 3, 2011
Lactation Rooms
The New York Times has a great article on the relatively new "lactation suites" at our nation's Capitol. Apparently they're one of the few bipartisan meeting places there!
I've had what I imagine is a fairly typical experience with trying to pump breastmilk at work: lots of people have good intentions to help, but it's been quite difficult at times.
Stanford's medical school has a brand new, enormous, beautiful building called the Li Ka Shing Center. Unfortunately, when it was being set up, someone forgot that half of the population can have babies, that those babies need breast milk, and that breast milk often needs to be pumped while women are at work and school--so when it opened, there was no designated space for pumping.
"What's the big deal?" you might think. Why can't you just use the restroom? Well, aside from the small matter of hygiene (you don't prepare your meals in the bathroom), the bathrooms in the new medical school building only have power outlets right next to the sink. Out of desperation, I did stand next to the sink once to pump, and just winced every time someone walked in--but that was pretty bad. Unlike when you're nursing a baby, your breasts are quite exposed when you're pumping, and if you're like me, you feel utterly ridiculous. So you actually appreciate a good amount of privacy.
Eventually an empty breakroom was designated as the place to pump. Unfortunately, the room is locked, and they won't give me a key. So I have to request a key from someone every time I need to pump (every few hours). This is bad for several reasons:
I've had what I imagine is a fairly typical experience with trying to pump breastmilk at work: lots of people have good intentions to help, but it's been quite difficult at times.
Stanford's medical school has a brand new, enormous, beautiful building called the Li Ka Shing Center. Unfortunately, when it was being set up, someone forgot that half of the population can have babies, that those babies need breast milk, and that breast milk often needs to be pumped while women are at work and school--so when it opened, there was no designated space for pumping.
"What's the big deal?" you might think. Why can't you just use the restroom? Well, aside from the small matter of hygiene (you don't prepare your meals in the bathroom), the bathrooms in the new medical school building only have power outlets right next to the sink. Out of desperation, I did stand next to the sink once to pump, and just winced every time someone walked in--but that was pretty bad. Unlike when you're nursing a baby, your breasts are quite exposed when you're pumping, and if you're like me, you feel utterly ridiculous. So you actually appreciate a good amount of privacy.
Eventually an empty breakroom was designated as the place to pump. Unfortunately, the room is locked, and they won't give me a key. So I have to request a key from someone every time I need to pump (every few hours). This is bad for several reasons:
1) Going to get the key and then give it back adds (in the best scenario) about 5 minutes to a process that you really want to be as quick as possible.
2) Frequently the person with the key is not available; either they've stepped away from their desk, or it's lunch time, or it's after 5 pm. This can mean spending extra time--up to 15 minutes chasing various people down--to find someone else with a key...or that I'm just out of luck.
3) Finally, during the many times I've had to run around explaining to various people that I needed to get into this room to pump breastmilk, I've realized that it's pretty demeaning to have to ask permission to do this. I shouldn't have to ask permission, nor should I have to explain to 3 or 4 people what I need the key for every time I need it.
The other non-ideal feature of this room is that the lights are on a motion detector timer--which is set to turn off every 15 seconds if you're not walking around. Since the room doesn't have windows, this means that you're plunged into darkness every 15 seconds, at which point you have to stand up--still pumping--to get the lights to turn back on.
It's been 6 months since I first requested a space for pumping, and 3 months since the situation has been this particular locked room. Not ideal. So what are the ideal features for a lactation room? Chime in in the comments!
Friday, December 31, 2010
The siren screen: resolutions past and present
When I was about 7 months pregnant, my husband and I made a deal. We got rid of our big old TV, and for his birthday he got two presents: a really nice electronic keyboard piano that fit in the corner formerly occupied by the TV, and a tiny (11") portable TV-with-DVD player that could be tucked away inside our storage ottoman unless it was urgently needed to watch the play-offs of one sport or another. We were both pretty happy with this compromise, and agreed that we would be providing a healthier home for our soon-to-be-born child without a TV around all the time.
And then my daughter was born, and I was incredibly grateful for the convenience of a screen of a different kind: my laptop. For the first couple months of her life, she was pretty much either nursing or sleeping. And during daylight hours, she liked to be held (and I liked to hold her!) constantly. Since we hadn't yet achieved one-handed nursing (I think that was around the 2 month mark, although my memory fails me somewhat), reading was quite difficult. I mean, I could lay a book or magazine in my lap, but I would then get incredibly frustrated when I finished reading one page and couldn't turn to the next!
So, a laptop enabled me to watch some TV shows, read the New York Times, and so on, all while nursing my daughter or holding her as she slept. I became really good at navigating my laptop with my toes. No, really. I could even sign into Gmail with my toes. I was that good. It may seem strange that I could type with my toes but not turn pages--but that's the honest-to-goodness truth. I found that when I tried to turn pages with my feet, I would inevitably turn 3 pages at once, and then could never get back.
But gradually, my daughter started to be more and more awake during the day, and she liked playing down on the floor with me next to her. Somewhere around the 3 to 4 month mark, I realized that I still had my laptop around almost constantly, even though the baby was no longer always asleep. And I started to worry about the effects of her seeing my eyes constantly drawn to the screen.
So I resolved to try and use the laptop very little while my daughter was awake. It was hard, though. As one commenter pointed out on a previous post about being a (temporary, anyway) stay-at-home-mother, it can be pretty boring to play with a very young baby. The laptop is so tempting! It positively beckons you over with its glowing screen, its promises of connection and relevance and videos of puppies...
Finally, last month, I rearranged some furniture and put a desk in the nursery. The only thing on the desk is my laptop, the charger for which is plugged in behind the desk. And finally, avoiding laptop use while baby is awake has gotten a little bit easier. If I don't remove the laptop from the desk, and I don't sit at the desk with baby (which she is unlikely to put up with), the problem is mostly solved. But it still requires some willpower.
So my resolution for the New Year? Separate screen time from baby time. Keep the laptop on the desk and the baby where she belongs--far away from screens of all kinds, fully engaged and exploring this big wonderful world of ours.
And then my daughter was born, and I was incredibly grateful for the convenience of a screen of a different kind: my laptop. For the first couple months of her life, she was pretty much either nursing or sleeping. And during daylight hours, she liked to be held (and I liked to hold her!) constantly. Since we hadn't yet achieved one-handed nursing (I think that was around the 2 month mark, although my memory fails me somewhat), reading was quite difficult. I mean, I could lay a book or magazine in my lap, but I would then get incredibly frustrated when I finished reading one page and couldn't turn to the next!
So, a laptop enabled me to watch some TV shows, read the New York Times, and so on, all while nursing my daughter or holding her as she slept. I became really good at navigating my laptop with my toes. No, really. I could even sign into Gmail with my toes. I was that good. It may seem strange that I could type with my toes but not turn pages--but that's the honest-to-goodness truth. I found that when I tried to turn pages with my feet, I would inevitably turn 3 pages at once, and then could never get back.
But gradually, my daughter started to be more and more awake during the day, and she liked playing down on the floor with me next to her. Somewhere around the 3 to 4 month mark, I realized that I still had my laptop around almost constantly, even though the baby was no longer always asleep. And I started to worry about the effects of her seeing my eyes constantly drawn to the screen.
So I resolved to try and use the laptop very little while my daughter was awake. It was hard, though. As one commenter pointed out on a previous post about being a (temporary, anyway) stay-at-home-mother, it can be pretty boring to play with a very young baby. The laptop is so tempting! It positively beckons you over with its glowing screen, its promises of connection and relevance and videos of puppies...
Finally, last month, I rearranged some furniture and put a desk in the nursery. The only thing on the desk is my laptop, the charger for which is plugged in behind the desk. And finally, avoiding laptop use while baby is awake has gotten a little bit easier. If I don't remove the laptop from the desk, and I don't sit at the desk with baby (which she is unlikely to put up with), the problem is mostly solved. But it still requires some willpower.
 |
| The laptop's new home |
Monday, December 27, 2010
An ode to the hand pump
Breastfeeding is a wonderful part of being a new mother. Unfortunately, breastfeeding usually necessitates pumping, which is not so wonderful.
[For those uninitiated: you have to pump for 3 reasons. 1) To store milk that can be used the next time you want to leave your baby with someone who isn't lactating, 2) to keep up your supply; breastfeeding is like Econ 101, all about supply and demand, so if you don't empty your breasts as often, they will start making less, and 3) because your breasts will get so full of milk after 3 or 4 hours that they become quite uncomfortable. Not to mention leaky!]
The amount of equipment that it seems necessary to acquire before you pump for the first time is unbelievable, and I found it quite intimidating. There's the breast pump itself, which can run to hundreds of dollars for a good electric model. Then you need something to pump the milk into--a bottle--which may or may not be the same as the container you store the milk in, which, believe it or not, may not be the same as the bottle you use to serve the milk to the baby. And you really would not believe the number of different kinds of bottles that are out there. Plastic, glass, standard cap, wide-mouthed, slow flow, medium flow, upturned nipple, broad-based nipple...it goes on and on.
So, I got all that stuff. And for the first 4 or 5 months, I used my electric pump. But for the last month or so, I've been able to do most of my pumping at home, and since I wasn't so pressed for time, I started to use this little manual pump that I was given for free at the hospital.
[For those uninitiated: you have to pump for 3 reasons. 1) To store milk that can be used the next time you want to leave your baby with someone who isn't lactating, 2) to keep up your supply; breastfeeding is like Econ 101, all about supply and demand, so if you don't empty your breasts as often, they will start making less, and 3) because your breasts will get so full of milk after 3 or 4 hours that they become quite uncomfortable. Not to mention leaky!]
The amount of equipment that it seems necessary to acquire before you pump for the first time is unbelievable, and I found it quite intimidating. There's the breast pump itself, which can run to hundreds of dollars for a good electric model. Then you need something to pump the milk into--a bottle--which may or may not be the same as the container you store the milk in, which, believe it or not, may not be the same as the bottle you use to serve the milk to the baby. And you really would not believe the number of different kinds of bottles that are out there. Plastic, glass, standard cap, wide-mouthed, slow flow, medium flow, upturned nipple, broad-based nipple...it goes on and on.
So, I got all that stuff. And for the first 4 or 5 months, I used my electric pump. But for the last month or so, I've been able to do most of my pumping at home, and since I wasn't so pressed for time, I started to use this little manual pump that I was given for free at the hospital.
Friday, December 17, 2010
On breastfeeding and pleasure
One of the things I wondered about before I became a mother was whether nursing a baby would feel good. (This is basically the adult woman's answer to the teenage wonder about what sex feels like). Now that I've crossed over, I can tell you: sort of.
I think my previous curiosity was specifically about whether there was physical pleasure at the breast from a suckling baby. The answer for me? No. Not at all. At best, the physical sensation at the breast is neutral; at worst, and especially for the first couple weeks, it hurts a bit.
But...is breastfeeding physically pleasurable, in a more general sense? Absolutely. The feeling of your baby sinking into your arms, her belly filling with milk, her warm little limbs going limp in sleep--it's wonderful. A warmth washes over me almost every time. Love that oxytocin. So there's whole-body pleasure, and it's definitely physical, but it doesn't feel like it emanates from your boobs the way I thought it might before I tried it.
And it occurred to me--there are plenty of things that we can do for ourselves that make ourselves feel good. Eating chocolate. Solving a hard math problem. Finishing a race. Some of those things are even good for us!
But can you think of anything else that we do that's good for other people and also involves very tangible pleasure for yourself? OK, aside from sex (but that's because the other person is also, hopefully, doing for you). I know, I know, you feel good when you serve others in an abstract, intellectual way--you may even get an emotional rush. But that warm rush that you get when you're breastfeeding your baby?
I think it might be the singular experience of feeling physical pleasure from taking care of someone else.
(Sorry, men).
I think my previous curiosity was specifically about whether there was physical pleasure at the breast from a suckling baby. The answer for me? No. Not at all. At best, the physical sensation at the breast is neutral; at worst, and especially for the first couple weeks, it hurts a bit.
But...is breastfeeding physically pleasurable, in a more general sense? Absolutely. The feeling of your baby sinking into your arms, her belly filling with milk, her warm little limbs going limp in sleep--it's wonderful. A warmth washes over me almost every time. Love that oxytocin. So there's whole-body pleasure, and it's definitely physical, but it doesn't feel like it emanates from your boobs the way I thought it might before I tried it.
And it occurred to me--there are plenty of things that we can do for ourselves that make ourselves feel good. Eating chocolate. Solving a hard math problem. Finishing a race. Some of those things are even good for us!
But can you think of anything else that we do that's good for other people and also involves very tangible pleasure for yourself? OK, aside from sex (but that's because the other person is also, hopefully, doing for you). I know, I know, you feel good when you serve others in an abstract, intellectual way--you may even get an emotional rush. But that warm rush that you get when you're breastfeeding your baby?
I think it might be the singular experience of feeling physical pleasure from taking care of someone else.
(Sorry, men).
 |
| Well, actually, they look pretty cozy. |
Thursday, December 16, 2010
The importance of being naked
In medical school, I'm a teaching assistant for the first year course in the medical interview and physical exam. One of the things we repeat ad nauseum is that a thorough physical exam cannot be done through clothing. We have to say it over and over because students (and many doctors, for that matter) are understandably uncomfortable asking patients to get undressed. It's cold, and the gowns are ridiculous, and if you're a student, you're probably still nervous about your competence with the exam.
But guess what? The moral of the story below is, you've gotta get your patients undressed. Read on for the story.
Shortly after getting a flu shot and my TDAP booster (tetanus, diptheria, pertussis--recommended for all adults who have contact with very young children), I started to feel achy and slightly feverish. I was a little better the next afternoon, but then my fever started to climb. And it just got worse and worse. That night, I had to change my pajamas because of sweating through them.
(New moms: you'll understand that my initial reaction when I woke up soaking wet was not "oh, I have night sweats!"...but rather, "hmmm, better sniff it. Is it breast milk? Pee? Spit up? So many possibilities...").
48 hours later, with my fever unrelenting, I decided to go into a local urgent care clinic. My temperature was 103.5. I was convinced that I was having a really strong--and unusual--reaction to the vaccines I'd just gotten. The doctor I saw didn't know what was going on. She examined me, heard a bit of a heart murmur (which I'd never had before), and began to order tests willy-nilly, grasping at diagnostic straws. I had brought my baby into the clinic with me, and mentioned several times when I spoke to my doctor that I was nursing--I wanted to be sure that any medicine she prescribed was safe to use while breastfeeding.
Finally, after putting a call into the clinic's infectious disease specialist, the doctor came back in to listen again to my heart murmur. This time, she asked me to slip off my bra. When I did, my nursing pads (non-moms: you've gotta wear these to collect leaks) fell out. And she said "oh! you're breastfeeding!" Which I had said at least 3 times already, but anyway. Something had clicked in her head. She started to examine my breasts carefully, and found a slightly red, slightly hard, wedge-shaped area on the left breast.
"Oh my god," she said. "How many times do I have to learn this lesson? Always take your patients' clothes off!"
"Huh?" I said.
"You have mastitis!"*
Oh. It turned out that my real, but brief, reaction to the shots had been a temporal coincidence.** What wasn't a coincidence? That once my doctor had finally done a thorough physical exam--with my clothes off--the diagnosis was simple.
I'll be helping to teach the physical exam next quarter; heaven help the first student I have who tries to listen to a heart through a gown or bra!
*An infection of the breast
**Or maybe not. Baby and I were both unusually sleepy the day after the shots, nursed less often than usual, and may have brought on the mastitis that way.
But guess what? The moral of the story below is, you've gotta get your patients undressed. Read on for the story.
Shortly after getting a flu shot and my TDAP booster (tetanus, diptheria, pertussis--recommended for all adults who have contact with very young children), I started to feel achy and slightly feverish. I was a little better the next afternoon, but then my fever started to climb. And it just got worse and worse. That night, I had to change my pajamas because of sweating through them.
(New moms: you'll understand that my initial reaction when I woke up soaking wet was not "oh, I have night sweats!"...but rather, "hmmm, better sniff it. Is it breast milk? Pee? Spit up? So many possibilities...").
48 hours later, with my fever unrelenting, I decided to go into a local urgent care clinic. My temperature was 103.5. I was convinced that I was having a really strong--and unusual--reaction to the vaccines I'd just gotten. The doctor I saw didn't know what was going on. She examined me, heard a bit of a heart murmur (which I'd never had before), and began to order tests willy-nilly, grasping at diagnostic straws. I had brought my baby into the clinic with me, and mentioned several times when I spoke to my doctor that I was nursing--I wanted to be sure that any medicine she prescribed was safe to use while breastfeeding.
Finally, after putting a call into the clinic's infectious disease specialist, the doctor came back in to listen again to my heart murmur. This time, she asked me to slip off my bra. When I did, my nursing pads (non-moms: you've gotta wear these to collect leaks) fell out. And she said "oh! you're breastfeeding!" Which I had said at least 3 times already, but anyway. Something had clicked in her head. She started to examine my breasts carefully, and found a slightly red, slightly hard, wedge-shaped area on the left breast.
"Oh my god," she said. "How many times do I have to learn this lesson? Always take your patients' clothes off!"
"Huh?" I said.
"You have mastitis!"*
Oh. It turned out that my real, but brief, reaction to the shots had been a temporal coincidence.** What wasn't a coincidence? That once my doctor had finally done a thorough physical exam--with my clothes off--the diagnosis was simple.
I'll be helping to teach the physical exam next quarter; heaven help the first student I have who tries to listen to a heart through a gown or bra!
*An infection of the breast
**Or maybe not. Baby and I were both unusually sleepy the day after the shots, nursed less often than usual, and may have brought on the mastitis that way.
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